Provider Demographics
NPI:1336365378
Name:NAWROCKI, GARY CHARLES (DMD FAGD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHARLES
Last Name:NAWROCKI
Suffix:
Gender:M
Credentials:DMD FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 N BANANA RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3697
Mailing Address - Country:US
Mailing Address - Phone:321-783-7514
Mailing Address - Fax:321-783-1713
Practice Address - Street 1:4301 N BANANA RIVER BLVD
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3697
Practice Address - Country:US
Practice Address - Phone:321-783-7514
Practice Address - Fax:321-783-1713
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist